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  • Age-related and gender-stratified differences in the association between high triglyceride and risk of hyperuricemia

    • 1,
    • 1,
    • 2,
    • 1,
    • 1,
    • 2,
    • 3,
    • 1,
    • 1,
    • 1,
    • 1Email author and
    • 2Email author
    Contributed equally
    Lipids in Health and Disease201918:147

    https://doi.org/10.1186/s12944-019-1077-5

    • Received: 14 February 2019
    • Accepted: 22 May 2019
    • Published:

    Abstract

    Background

    Elevated serum uric acid is commonly associated with high triglyceride. However, the relation of triglyceride and hyperuricemia in different gender and age groups is currently not well understood. This study aimed to evaluate age- and gender-related association of high triglyceride with hyperuricemia in a subgroup of Chinese population.

    Methods

    We retrospectively analyzed physical examination data of 24,438 subjects (12,557 men and 11,881 women) in Kaifeng, China. The alanine aminotransferase, γ-glutamyl transpeptidase, serum creatinine, blood urea nitrogen, total cholesterol, high-density lipoprotein cholesterol, triglyceride and serum uric acid were measured in all subjects. The triglyceride was categorized into < 1.21, 1.21 ~, 1.7 ~, 2.83 ~ and >  5.6 mmol/L subgroups, and odds ratio (OR) and 95% confidence interval (CI) of hyperuricemia were calculated by logistic regression analysis.

    Results

    Univariate and age-adjusted analyses showed that high triglyceride was positively associated with hyperuricemia (p <  0.01). Further age-stratified analysis showed that the positive association was significant in the 20 ~, 30 ~, 40 ~, 50 ~, 60 ~ and 80 ~ age groups in men. In women, no statistically significant was found in 60 ~ and 70 ~ age groups.

    Conclusion

    High triglyceride is positively associated with hyperuricemia in both men and women, and this association is age-related, especially in women.

    Keywords

    • Hyperuricemia
    • Triglyceride
    • Risk
    • Age-related

    Background

    Hyperuricemia is widely considered as a key risk factor for metabolic syndrome, including dyslipidemia, in which hypertriglyceridemia is the most common lipid abnormality [16]. High uric acid (UA) levels were associated with increased triglyceridemia, independently of metabolic syndrome [7]. A survey of the prevalence of obesity in China during 2004 to 2008 showed that all rural areas had a low prevalence of obesity except in Henan, probably because of differences in diet [8]. Furthermore, a recent meta-analysis evaluating 302,430 individuals free of known vascular disease at baseline in 68 prospective studies showed that high triglyceride had a strong association with both cardiovascular disease and ischemic stroke [9]. In addition, the secondary prevention of those diseases and antihyperuricemic therapy involve long term and high costs [1012]. Therefore, if we can identify the link of triglycerides with hyperuricemia in different age groups, more people will benefit.

    Liou et al. reported that uric acid aggregated with log value of triglycerides but concluded that metabolic syndrome was not associated with hyperuricemia [13]. However, an Indian study enrolling 121 healthy men suggested that serum uric acid level was a good indicator of the level of triglyceride [14]. At present, little is known whether serum uric acid level and high triglyceride has the similar relationship in Chinese in different age-groups. Therefore, this study aimed to investigate the association of high triglyceride with the risk of hyperuricemia in different genders and age-groups using physical examination data from a hospital-based physical examination center in Kaifeng, China.

    Methods

    Subjects

    This study was approved by Ethics Committee of Huaihe Hospital of Henan University and all subjected provided written consent. The subjects were participants of physical examination at the Physical Examination Center of Huaihe Hospital of Henan University. Total number of the subjects were 38,475 consecutive participants from 2003 to 2017. After excluding subjects without available data on age, gender, total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), alanine aminotransferase (ALT), γ-glutamyl transpeptidase (γ-GT), blood urea nitrogen (BUN) and serum creatinine (SCr), a total of 24,438 eligible subjects (12,557 men and 11,881 women) were included in the final analysis (Fig. 1).
    Fig. 1
    Fig. 1

    Flow chart of participants

    Serum uric acid and lipids measurements

    Blood samples from participants undergoing an overnight fasting were collected in the morning and analyzed within an hour in hospital. Blood sample was tested using an autoanalyzer (Model 7600, HITACHI, Japan). Hyperuricemia was defined by the following criteria: men: serum uric acid ≥440 μmol/L, women: serum uric acid ≥360 μmol/L and categorized all the variables as follows: the plasma triglyceride were categorized into < 1.21 (normal), 1.21 ~ (above normal), 1.7 ~ (slightly damaged), 2.83 ~ (moderately damaged) and >  5.6 mmol/L (severely damaged) subgroups, and we combined the slightly, moderately, and severely damaged TG into a Damaged TG group; age was categorized into < 20, 20 ~, 30 ~, 40 ~, 50 ~, 60 ~, 70 ~, and 80 ~ years age subgroups; ALT was dichotomized into normal (≤ 40 U/L) and abnormal (> 40 U/L) subgroups; γ-GT was categorized into low (< 16 U/L), normal (16 ~ 73 U/L) and high (> 73 U/L) subgroups; SCr was categorized into low (men: < 54 mmol/L, women: < 44 mmol/L), normal (men: 54 ~ 106 mmol/L, women: 44 ~ 97 mmol/L) and high (men: > 106 mmol/L, women: > 97 mmol/L) subgroups; BUN was categorized into low (< 2.86 μmol/L), normal (2.86 ~ 7.14 μmol/L) and high (> 7.14 μmol/L) subgroups; TC was categorized into low (< 2.8 mmol/L), normal (2.8 ~ 5.17 mmol/L) and high subgroups (> 5.17 mmol/L); plasma glucose was categorized into low FPG (< 3.9 mmol/L), normal FPG (3.9 ~ mmol/L), impaired FPG (6.1 ~ mmol/L) and diabetic FPG (> 7.0 mmol/L) subgroups; and HDL-C was categorized into low (< 0.9 mmol/L), normal (0.9 ~ 2.19 mmol/L) and high (> 2.19 mmol/L) subgroups.

    Statistical analysis

    Statistical analysis was performed using Stata version 13 (StataCorp LLC, TX, USA). The chi-squared test was used to analyze the differences in the distribution of TG categories. Three models with progressive degrees of adjustment were used to evaluate the relationship between hyperuricemia with TG for men and women, separately. Model 1 was a univariate logistic regression model; Model 2 was an age-adjusted logistic regression model, and Model 3 was a multivariate logistic regression model (adjusted for age, ALT, γ-GT, SCr, BUN, TC, FPG, and HDL-C). Multivariable logistic regression analysis were used to calculate age-stratified association of TG and hyperuricemia for both men and women. Odds ratio (OR) and 95% confidence intervals (CI) were estimated in the logistical regression analysis. p <  0.05 was considered significant.

    Results

    We observed an increasing trend in the proportion of the Damaged TG group when the age increased from 20 to 40 years; thereafter, the proportion of the Damaged TG group started to decrease with age in men (Fig. 2). There was a growing trend of the proportion of the Damaged TG group among women with a flat plateau from 60 years of age (Fig. 3).
    Fig. 2
    Fig. 2

    Changes of triglyceride levels with age in men

    Fig. 3
    Fig. 3

    Changes of triglyceride levels with age in women

    In Table 1, the Damaged TG group (1.7 ~, 2.83 ~ and >  5.6 mmol/L subgroups) had a higher proportion to have high levels of serum ALT, γ-GT, TC and hyperuricemia (all p <  0.05), but had a lower proportion to have high level of serum HDL-C (p <  0.001) in both genders.
    Table 1

    Characteristics of the participants of physical examinations by fasting plasma triglyceride categories (mmol/L) in men and women

     

    Men, fasting plasma triglyceride (mmol/L)

    Women, fasting plasma triglyceride (mmol/L)

    No. of participants

    <  1.21

    1.21 ~

    1.7 ~

    2.83 ~

    >  5.6

    P-value

    No. of participants

    <  1.21

    1.21 ~

    1.7 ~

    2.83 ~

    >  5.6

    P-value

    No. of participants

    12,557

    4293 (34.2)

    3040 (24.2)

    3335 (26.6)

    1546 (12.3)

    343 (2.7)

     

    11,881

    6023 (50.7)

    2661 (22.4)

    2353 (19.8)

    747 (6.3)

    97 (0.8)

     

    Age (years), n (%)

     < 20

    43

    33 (76.7)

    4 (9.3)

    5 (11.6)

    0 (0.0)

    1 (2.3)

    <  0.001

    22

    17 (77.3)

    3 (13.6)

    2 (9.1)

    0 (0.0)

    0 (0.0)

    <  0.001

     20 ~

    1325

    609 (46.0)

    324 (24.5)

    244 (18.4)

    125 (9.4)

    23 (1.7)

     

    1880

    1335 (71.0)

    264 (14.0)

    190 (10.1)

    81 (4.3)

    10 (0.5)

     

     30 ~

    2348

    702 (29.9)

    540 (23.0)

    669 (28.5)

    342 (14.6)

    95 (4.1)

     

    2485

    1582 (63.7)

    473 (19.0)

    324 (13.0)

    89 (3.6)

    17 (0.7)

     

     40 ~

    3133

    858 (27.4)

    704 (22.5)

    938 (29.9)

    505 (16.1)

    128 (4.1)

     

    2652

    1496 (56.4)

    578 (21.8)

    436 (16.4)

    128 (4.8)

    14 (0.5)

     

     50 ~

    2735

    879 (32.1)

    680 (24.9)

    764 (27.9)

    349 (12.8)

    63 (2.3)

     

    2492

    904 (36.3)

    679 (27.3)

    654 (26.2)

    224 (9.0)

    31 (1.2)

     

     60 ~

    1848

    684 (37.0)

    474 (25.7)

    510 (27.6)

    157 (8.5)

    23 (1.2)

     

    1509

    424 (28.1)

    441 (29.2)

    480 (31.8)

    146 (9.7)

    18 (1.2)

     

     70 ~

    848

    386 (45.5)

    233 (27.5)

    166 (19.6)

    56 (6.6)

    7 (0.8)

     

    679

    214 (31.5)

    172 (25.3)

    222 (32.7)

    64 (9.4)

    7 (1.0)

     

     80 ~

    277

    142 (51.3)

    81 (29.2)

    39 (14.1)

    12 (4.3)

    3 (1.1)

     

    162

    51 (31.5)

    51 (31.5)

    45 (27.8)

    15 (9.3)

    0 (0.0)

     

    Alanine Aminotransferase (U/L), n (%)

     <= 40

    10,864

    3974 (36.6)

    2694 (24.8)

    2812 (25.9)

    1165 (10.7)

    219 (2.0)

    <  0.001

    11,289

    5856 (51.9)

    2514 (22.3)

    2172 (19.2)

    661 (5.9)

    86 (0.8)

    <  0.001

     >  40

    1693

    319 (18.8)

    346 (20.4)

    523 (30.9)

    381 (22.5)

    124 (7.3)

     

    592

    167 (28.2)

    147 (24.8)

    181 (30.6)

    86 (14.5)

    11 (1.9)

     

    γ-Glutamyl Transpeptidase (U/L), n (%)

     <  16

    1722

    1102 (64.0)

    375 (21.8)

    200 (11.6)

    39 (2.3)

    6 (0.4)

    <  0.001

    6207

    4088 (65.9)

    1253 (20.2)

    716 (11.5)

    138 (2.2)

    12 (0.2)

    <  0.001

     16 ~  73

    9724

    3077 (31.6)

    2509 (25.8)

    2766 (28.5)

    1168 (12.0)

    204 (2.1)

     

    5488

    1892 (34.5)

    1364 (24.9)

    1578 (28.8)

    575 (10.5)

    79 (1.4)

     

     >  73

    1111

    114 (10.3)

    156 (14.0)

    369 (33.2)

    339 (30.5)

    133 (12.0)

     

    186

    43 (23.1)

    44 (23.7)

    59 (31.7)

    34 (18.3)

    6 (3.2)

     

    Serum Creatinine (mmol/L), n (%)

     Men < 54 or Women < 44

    719

    281 (39.1)

    143 (19.9)

    168 (23.4)

    89 (12.4)

    38 (5.3)

    <  0.001

    1383

    688 (49.8)

    311 (22.5)

    261 (18.9)

    107 (7.7)

    16 (1.2)

    <  0.001

     Men: 54~106 or Women: 44~97

    11,715

    3978 (34.0)

    2862 (24.4)

    3143 (26.8)

    1431 (12.2)

    301 (2.6)

     

    10,461

    5325 (50.9)

    2339 (22.4)

    2085 (19.9)

    632 (6.0)

    80 (0.8)

     

     Men > 106 or Women > 97

    123

    34 (27.6)

    35 (28.5)

    24 (19.5)

    26 (21.1)

    4 (3.3)

     

    37

    10 (27.0)

    11 (29.7)

    7 (18.9)

    8 (21.6)

    1 (2.7)

     

    Blood Urea Nitrogen (μmol/L), n (%)

     <  2.86

    101

    36 (35.6)

    23 (22.8)

    26 (25.7)

    12 (11.9)

    4 (4.0)

    <  0.001

    523

    300 (57.4)

    110 (21.0)

    81 (15.5)

    30 (5.7)

    2 (0.4)

    0.027

     2.86 ~  7.14

    11,465

    3853 (33.6)

    2779 (24.2)

    3103 (27.1)

    1420 (12.4)

    310 (2.7)

     

    11,016

    5570 (50.6)

    2469 (22.4)

    2196 (19.9)

    690 (6.3)

    91 (0.8)

     

     >  7.14

    991

    404 (40.8)

    238 (24.0)

    206 (20.8)

    114 (11.5)

    29 (2.9)

     

    342

    153 (44.7)

    82 (24.0)

    76 (22.2)

    27 (7.9)

    4 (1.2)

     

    Total Cholesterol (mmol/L), n (%)

     <  2.8

    82

    66 (80.5)

    12 (14.6)

    3 (3.7)

    1 (1.2)

    0 (0.0)

    <  0.001

    44

    34 (77.3)

    6 (13.6)

    4 (9.1)

    0 (0.0)

    0 (0.0)

    <  0.001

     2.8 ~  5.17

    7665

    3252 (42.4)

    1878 (24.5)

    1777 (23.2)

    671 (8.8)

    87 (1.1)

     

    7273

    4561 (62.7)

    1425 (19.6)

    970 (13.3)

    287 (4.0)

    30 (0.4)

     

     >  5.17

    4810

    975 (20.3)

    1150 (23.9)

    1555 (32.3)

    874 (18.2)

    256 (5.3)

     

    4564

    1428 (31.3)

    1230 (27.0)

    1379 (30.2)

    460 (10.1)

    67 (1.5)

     

    Fasting plasma glucose (mmol/L), n (%)

     <  3.9

    20

    9 (45.0)

    6 (30.0)

    2 (10.0)

    3 (15.0)

    0 (0.0)

     

    20

    9 (45.0)

    5 (25.0)

    3 (15.0)

    2 (10.0)

    1 (5.0)

    <  0.001

     3.9 ~

    9833

    3591 (36.5)

    2447 (24.9)

    2521 (25.6)

    1062 (10.8)

    212 (2.2)

    <  0.001

    10,194

    5607 (55.0)

    2217 (21.8)

    1814 (17.8)

    497 (4.9)

    59 (0.6)

     

     6.1 ~

    1370

    368 (26.9)

    309 (22.6)

    416 (30.4)

    218 (15.9)

    59 (4.3)

     

    933

    245 (26.3)

    263 (28.2)

    290 (31.1)

    119 (12.8)

    16 (1.7)

     

     >  7.0

    1334

    325 (24.4)

    278 (20.8)

    396 (29.7)

    263 (19.7)

    72 (5.4)

     

    734

    162 (22.1)

    176 (24.0)

    246 (33.5)

    129 (17.6)

    21 (2.9)

     

    High Density Lipoprotein Cholesterol (mmol/L), n (%)

     <  0.9

    2274

    371 (16.3)

    465 (20.5)

    775 (34.1)

    502 (22.1)

    161 (7.1)

    <  0.001

    709

    98 (13.8)

    134 (18.9)

    234 (33.0)

    197 (27.8)

    46 (6.5)

    <  0.001

     0.9 ~  2.19

    10,262

    3904 (38.0)

    2573 (25.1)

    2559 (24.9)

    1044 (10.2)

    182 (1.8)

     

    11,093

    5865 (52.9)

    2514 (22.7)

    2115 (19.1)

    548 (4.9)

    51 (0.5)

     

     >  2.19

    21

    18 (85.7)

    2 (9.5)

    1 (4.8)

    0 (0.0)

    0 (0.0)

     

    79

    60 (76.0)

    13 (16.5)

    4 (5.1)

    2 (2.5)

    0 (0.0)

     

    Hyperuricemia (men > 440 μmol/L or women > 360 μmol/L)

     No

    11,305

    4068 (36.0)

    2791 (24.7)

    2948 (26.1)

    1246 (11.0)

    252 (2.2)

    <  0.001

    11,193

    5877 (52.5)

    2507 (22.4)

    2112 (18.9)

    614 (5.5)

    83 (0.7)

    <  0.001

     Yes

    1252

    225 (18.0)

    249 (19.9)

    387 (30.9)

    300 (24.0)

    91 (7.3)

     

    688

    146 (21.2)

    154 (22.4)

    241 (35.0)

    133 (19.3)

    14 (2.0)

     
    Univariate logistical regression analysis (Model 1) in men showed that the above normal, slightly damaged, moderately damaged and severely damaged TG subgroups had an OR of 1.61 (95% CI: 1.34–1.94), 2.37 (95% CI: 2.00–2.82), 4.35 (95% CI: 3.62–5.23), and 6.53 (95% CI: 4.96–8.59), respectively; age-adjusted logistical regression analysis (Model 2) and multivariate logistical regression model (Model 3) showed a similar trend (Table 2). In all three models, the OR of hyperuricemia was positively associated with an increase in TG (p <  0.001). In women, age-adjusted logistic regression analysis showed a similar trend to that of univariate logistic regression model, in accordance with the results in men. Moderately damaged and severely damaged TG subgroups in Model 3 showed an OR of 5.42 (95% CI: 4.03–7.28) and 4.01 (95% CI: 2.13–7.55), respectively. In women, all the three models showed that TG was positively associated with risk for hyperuricemia (all p <  0.001).
    Table 2

    Odds ratio of hyperuricemia among fasting plasma triglyceride (mmol/L) in men and womena

     

    Men, fasting plasma triglyceride (mmol/L)

    Women, fasting plasma triglyceride (mmol/L)

    <  1.21

    1.21 ~

    1.7 ~

    2.83 ~

    >  5.6

    P for trendb

    <  1.21

    1.21 ~

    1.7 ~

    2.83 ~

    >  5.6

    P for trendb

    No. of participants

    4293

    3040

    3335

    1546

    343

     

    6023

    2661

    2353

    747

    97

     

    Hyperuricemiac

     Cases

    225

    249

    387

    300

    91

     

    146

    154

    241

    133

    14

     

     Rate (%)

    5.2

    8.2

    11.6

    19.4

    26.5

     

    2.4

    5.8

    10.2

    17.8

    14.4

     

     Model 1, OR (95% CI)

    1.00

    1.61 (1.34–1.94)

    2.37 (2.00–2.82)

    4.35 (3.62–5.23)

    6.53 (4.96–8.59)

    0.000

    1.00

    2.47 (1.96–3.12)

    4.59 (3.72–5.68)

    8.72 (6.80–11.19)

    6.79 (3.77–12.24)

    0.000

     Model 2, OR (95% CI)

    1.00

    1.62 (1.35–1.96)

    2.37 (2.00–2.81)

    4.26 (3.54–5.12)

    6.26 (4.76–8.25)

    0.000

    1.00

    2.35 (1.86–2.97)

    4.28 (3.44–5.33)

    8.16 (6.33–10.53)

    6.43 (3.56–11.61)

    0.000

     Model 3, OR (95% CI)

    1.00

    1.46 (1.21–1.77)

    1.99 (1.65–2.39)

    3.10 (2.51–3.82)

    4.27 (3.13–5.83)

    0.000

    1.00

    1.95 (1.53–2.50)

    3.20 (2.51–4.08)

    5.42 (4.03–7.28)

    4.01 (2.13–7.55)

    0.000

    aLogistic regression. Model 1, univariate; Model 2, adjusted with age; Model 3, adjusted with age, alanine aminotransferase (U/L), γ-glutamyl transpeptidase (U/L), serum creatinine (mmol/L), blood urea nitrogen (μmol/L), total cholesterol (mmol/L), plasma glucose (mmol/l), and high density lipoprotein cholesterol (mmol/L). OR Odds ratio, CI Confidence interval

    bContrasts of marginal linear predictions after logistic regression with Stata13

    cHyperuricemia:(men > 440 μmol/L or women > 360 μmol/L

    Multivariate logistic regression model showed that the positive association between hyperuricemia and TG was significant in men of 20~, 30 ~, 40 ~, 50 ~, 60 ~ and 80 ~ age subgroups (p <  0.05, Table 3). Increase in hyperuricemia in the severely damaged TG group was more significant for the 60~ age subgroup (OR = 12.07; 95% CI: 3.63–40.16). In women, the positive association was the lowest in the 50~ age group with increase in TG. No significant increase in hyperuricemia was observed in the 60 ~ (women) and 70 ~ (women and men) age groups (p > 0.05).
    Table 3

    Odds ratio of hyperuricemia among fasting plasma triglyceride (mmol/L) and age in men and womena

     

    Men, fasting plasma triglyceride (mmol/L)

    Women, fasting plasma triglyceride (mmol/L)

    No. of participants

    Case

    Rate (%)

    <  1.21

    1.21 ~

    1.7 ~

    2.83 ~

    >  5.6

    P for trendb

    No. of participants

    Case

    Rate (%)

    <  1.21

    1.21 ~

    1.7 ~

    2.83 ~

    >  5.6

    P for trendb

    No. of participants

    12,557

    1252

    10.0

    4293

    3040

    3335

    1546

    343

     

    11,881

    688

    5.8

    6023

    2661

    2353

    747

    97

     

    Hyperuricemiac

     < 20 yrs

    43

    10

    23.3

    1.00

    (−)

    (−)

    (−)

    (−)

    (−)

    22

    3

    13.6

    1.00

    (−)

    (−)

    (−)

    (−)

    (−)

     20~ yrs

    1325

    175

    13.2

    1.00

    1.02 (0.63–1.64)

    1.50 (0.92–2.45)

    2.40 (1.36–4.23)

    3.03 (1.11–8.22)

    0.005

    1880

    116

    6.2

    1.00

    2.26 (1.26–4.03)

    2.17 (1.13–4.16)

    5.98 (2.79–12.83)

    7.42 (1.43–38.36)

    0.004

     30~ yrs

    2348

    304

    12.9

    1.00

    1.70 (1.11–2.59)

    1.78 (1.18–2.70)

    3.10 (1.95–4.91)

    3.88 (2.06–7.30)

    0.000

    2485

    107

    4.3

    1.00

    3.01 (1.74–5.20)

    3.22 (1.75–5.90)

    6.64 (3.11–14.16)

    8.10 (2.10–31.17)

    0.000

     40~ yrs

    3133

    288

    9.2

    1.00

    1.80 (1.10–2.93)

    3.22 (2.06–5.02)

    4.92 (3.03–7.99)

    6.73 (3.58–12.68)

    0.000

    2652

    74

    2.8

    1.00

    3.48 (1.76–6.86)

    3.95 (1.91–8.18)

    6.13 (2.40–15.64)

    (−)

    0.001

     50~ yrs

    2735

    241

    8.8

    1.00

    1.38 (0.88–2.15)

    2.04 (1.34–3.11)

    4.07 (2.57–6.45)

    7.48 (3.77–14.85)

    0.000

    2492

    159

    6.4

    1.00

    1.58 (0.94–2.66)

    2.31 (1.38–3.86)

    4.12 (2.26–7.49)

    5.07 (1.71–15.00)

    0.000

     60~ yrs

    1848

    123

    6.7

    1.00

    2.20 (1.16–4.15)

    4.17 (2.29–7.59)

    5.43 (2.57–11.45)

    12.07 (3.63–40.16)

    0.000

    1509

    123

    8.2

    1.00

    0.82 (0.38–1.76)

    3.79 (1.99–7.22)

    5.59 (2.64–11.85)

    1.15 (0.13–10.08)

    0.549

     70~ yrs

    848

    81

    9.6

    1.00

    1.12 (0.58–2.16)

    1.07 (0.51–2.25)

    1.48 (0.55–3.99)

    4.46 (0.70–28.41)

    0.096

    679

    78

    11.5

    1.00

    1.53 (0.68–3.41)

    2.82 (1.34–5.97)

    1.06 (0.33–3.40)

    (−)

    0.570

     80~ yrs

    277

    30

    10.8

    1.00

    4.80 (1.58–14.56)

    5.04 (1.26–20.19)

    10.13 (1.58–64.80)

    (−)

    0.018

    162

    28

    17.3

    1.00

    1.70 (0.32–8.87)

    3.75 (0.71–19.67)

    16.75 (2.26–124.18)

    (−)

    0.006

    aLogistic regression model adjusted with alanine aminotransferase (U/L), γ-glutamyl transpeptidase (U/L), serum creatinine (mmol/L), blood urea nitrogen (μmol/L), total cholesterol (mmol/L), plasma glucose (mmol/L), and high density lipoprotein cholesterol (mmol/L)

    bContrasts of marginal linear predictions from 3.9~ though > 7.0 groups after logistic regression with Stata13

    cHyperuricemia:(men > 440 μmol/L or women > 360 μmol/L

    Considering the complicated relationship between triglyceride and glucose metabolism, we also analyzed the association of triglyceride-glucose index (TyG) with hyperuricemia. The results showed that TyG tended to be a better index of hyperuricemia in females than in males (Table 4). After being stratified by the age, the better behavior of TyG was concentrated in 40~ and 60~ age groups (Table 5).
    Table 4

    Odds ratio of hyperuricemia among triglyceride-glucose index in men and womena

     

    Men, triglyceride-glucose index (TyG)

    Women, triglyceride-glucose index (TyG)

    0 ~

    1st quatile ~

    2nd quatile ~

    3rd quatile ~

    P for trendb

    0 ~

    1st quatile ~

    2nd quatile ~

    3rd quatile ~

    P for trendb

    No. of  participants

    2169

    3034

    3410

    3944

     

    3924

    3057

    2701

    2199

     

    Hyperuricemiac

     Cases

    103

    199

    333

    617

     

    67

    114

    198

    309

     

     Rate (%)

    4.7

    6.6

    9.8

    15.6

     

    1.7

    3.7

    7.3

    14.1

     

     Model 1, OR (95% CI)

    1.00

    1.40 (1.10–1.79)

    2.16 (1.72–2.72)

    3.72 (3.00–4.62)

    <  0.001

    1.00

    2.23 (1.64–3.33)

    4.53 (3.41–6.71)

    9.41 (7.19–12.33)

    <  0.001

     Model 2, OR (95% CI)

    1.00

    1.47 (1.15–1.88)

    2.26 (1.80–2.85)

    3.90 (3.14–4.84)

    <  0.001

    1.00

    2.19 (1.61–2.98)

    4.39 (3.29–5.86)

    9.08 (6.85–12.72)

    <  0.001

     Model 3, OR (95% CI)

    1.00

    1.32 (1.03–1.72)

    1.85 (1.46–2.35)

    2.68 (2.11–3.41)

    <  0.001

    1.00

    1.90 (1.39–2.61)

    3.32 (2.44–4.52)

    6.08 (4.43–8.34)

    <  0.001

    aLogistic regression. Model 1, univariate; Model 2, adjusted with age; Model 3, adjusted with age, alanine aminotransferase (U/L), γ-glutamyl transpeptidase (U/L), serum creatinine (mmol/L), blood urea nitrogen (μmol/L), total cholesterol (mmol/L), and high density lipoprotein cholesterol (mmol/L). OR Odds ratio, CI Confidence interval

    bContrasts of marginal linear predictions after logistic regression with Stata13

    cHyperuricemia:(men > 440 μmol/L or women > 360 μmol/L

    Table 5

    Odds ratio of hyperuricemia among triglyceride-glucose index and age in men and womena

     

    Men, triglyceride-glucose index (TyG)

    Women, triglyceride-glucose index (TyG)

    No. of participants

    Case

    Rate (%)

    0 ~

    1st quatile ~

    2nd quatile ~

    3rd quatile ~

    P for trendb

    No. of participants

    Case

    Rate (%)

    0 ~

    1st quatile ~

    2nd quatile ~

    3rd quatile ~

    P for trendb

    No. of participants

    12,557

    1252

    10.0

    2169

    3034

    3410

    3944

     

    11,881

    688

    5.8

    3924

    3057

    2701

    2199

     

    Hyperuricemiac

     < 20 yrs

    43

    10

    23.3

    1.00

    4.98 (0.37–66.42)

    73.31 (1.18–4529.68)

    7.78 (0.20–297.59)

    0.135

    22

    3

    13.6

    1.00

    (−)

    (−)

    (−)

    (−)

     20~ yrs

    1325

    175

    13.2

    1.00

    1.19 (0.70–2.77)

    1.29 (0.76–2.18)

    2.44 (1.41–4.24)

    0.002

    1880

    116

    6.2

    1.00

    2.77 (1.50–5.97)

    2.49 (1.23–5.23)

    5.72 (2.82–11.61)

    <  0.001

     30~ yrs

    2348

    304

    12.9

    1.00

    1.30 (0.77–2.21)

    1.83 (1.11–3.32)

    2.27 (1.36–3.78)

    <  0.001

    2485

    107

    4.3

    1.00

    1.89 (0.96–3.69)

    4.15 (2.18–7.89)

    5.95 (2.92–12.11)

    <  0.000

     40~ yrs

    3133

    288

    9.2

    1.00

    0.98 (0.51–1.89)

    2.03 (1.13–3.65)

    3.77 (2.12–6.72)

    <  0.001

    2652

    74

    2.8

    1.00

    3.61 (1.29–13.86)

    9.42 (3.42–25.97)

    11.42 (3.87–33.73)

    <  0.001

     50~ yrs

    2735

    241

    8.8

    1.00

    1.54 (0.81–2.93)

    1.92 (1.04–3.54)

    3.31 (1.80–6.75)

    <  0.001

    2492

    159

    6.4

    1.00

    0.91 (0.46–1.79)

    1.64 (0.87–3.57)

    2.86 (1.51–5.42)

    0.002

     60~ yrs

    1848

    123

    6.7

    1.00

    3.17 (1.06–9.46)

    4.90 (1.67–14.37)

    6.46 (2.19–19.53)

    <  0.001

    1509

    123

    8.2

    1.00

    2.27 (0.62–8.31)

    3.98 (1.18–13.47)

    10.67 (3.17–35.98)

    <  0.001

     70~ yrs

    848

    81

    9.6

    1.00

    1.48 (0.62–3.54)

    1.35 (0.54–3.36)

    1.34 (0.53–3.41)

    0.600

    679

    78

    11.5

    1.00

    0.97 (0.30–3.14)

    1.60 (0.53–4.78)

    2.25 (0.74–6.83)

    0.198

     80~ yrs

    277

    30

    10.8

    1.00

    1.39 (0.29–6.72)

    6.16 (1.51–25.72)

    3.68 (0.72–18.71)

    0.035

    162

    28

    17.3

    (−)

    1.00

    3.08 (0.67–14.27)

    5.24 (1.10–24.87)

    0.321

    aLogistic regression model adjusted with alanine aminotransferase (U/L), γ-glutamyl transpeptidase (U/L), serum creatinine (mmol/L), blood urea nitrogen (μmol/L), total cholesterol (mmol/L), and high density lipoprotein cholesterol (mmol/L)

    bContrasts of marginal linear predictions from 3.9~ though > 7.0 groups after logistic regression with Stata13

    cHyperuricemia: men > 440 μmol/L or women > 360 μmol/L

    Discussion

    In this study, we found a positive relationship of high triglyceride with hyperuricemia in both men and women, in agreement with an Indian study [14]. Dietary habits have been changing in both China and India, and obesity and hypertriglyceridemia have begun to occur in younger people.

    The relationship of serum uric acid with triglyceridemia is still controversial. Earlier studies showed that hyperuricemia was always accompanied with hypertriglyceridemia initially [15, 16]. In addition, TG was more strongly associated with serum UA than HDL-C and TC, using the healthy examination data [17]. A Kuwait study further supported the close relation in dyslipidemic patients, a group already at high coronary artery disease risk [18]. Nevertheless, whether age and gender differences mediate the association between serum UA levels and TG is still controversial. In present study, we demonstrated that after adjustment with age (Model 2) and other confounding factors (Model 3), the OR still increased with the increase in TG. These results suggest that TG levels independently affect the incidence of hyperuricemia. However, in multivariate logistic regression analysis, the positive association between hyperuricemia and TG showed a gender and age differences and the positive association was the lowest in the 50~ age group. Whether decreasing level of estrogen after menopause is responsible for the differences needs further studies.

    Stelmach et al. investigated 607 Polish adults with hyperuricemia and demonstrated that the upper tertile of serum uric acid levels had higher TG values in males but not in females [19]. In contrast, Lippi et al. retrospectively enrolled a large cohort of unselected adult outpatients and showed that triglycerides were independently associated with serum UA in women but not in men [20]. Notably, in this study our data showed that high TG level was positively associated with the incidence of hyperuricemia in both men and women. This is consistent with a prospective study which demonstrated that hypertriglyceridemia in men might strengthen the effect of serum UA on the development of gout [21]. Chinese diet is characterized with a high-fat diet, particularly the overconsumption of cooking oil may be a significant risk factor for obesity [22, 23].

    To investigate lipid abnormalities in acute myocardial infarction (AMI) patients, Wei et al. retrospectively analyzed 1213 AMI patients in East China and showed a significant difference in triglycerides for male but not for female AMI patients [24]. Xu et al. found that older Chinese people had moderate and high levels of unbalanced diets [25]. Significant differences were influenced by many factors, such as gender, marital status, work status, education levels. These findings highlight complex interaction between hyperuricemia and TG. Differences in dietary patterns such as the proportion of carbohydrate or fat may be responsible for the variability in the relationship between serum uric acid and triglyceridemia.

    TyG index is proposed as a marker of moderate insulin resistance. Therefore, we analyzed the association of TyG with hyperuricemia. We found that TyG could be a better index of hyperuricemia in females than in males. However, a recent study indicated that TyG index presented the significant risks for chronic kidney disease in both men and women [26]. The reason for the disparities is unclear and need additional investigations.

    Our study has two main limitations. First, our study was conducted in a special group, so the generalizability of our findings to other population needs confirmation in future studies. Second, confounding factors such as diet patterns and health concerns among people of different ages were not included in our analysis, which may have an impact on the results. Further studies are required to elucidate the association between triglyceride and hyperuricemia in different gender and age groups.

    Conclusions

    Our study demonstrated that high triglyceride was positively associated with hyperuricemia in both men and women, and this association was age-related, especially in women.

    Notes

    Abbreviations

    ALT: 

    Alanine aminotransferase

    BUN: 

    Blood urea nitrogen

    HDL-C: 

    High-density lipoprotein cholesterol

    SCr: 

    Serum creatinine

    TC: 

    Total cholesterol

    TG: 

    Triglyceride

    UA: 

    Uric acid

    γ-GT: 

    γ-glutamyl transpeptidase

    Declarations

    Acknowledgements

    We thank all of participants in this study.

    Funding

    This work was supported by the Scientific and Technological Project of Henan Province (No. 201502017).

    Authors’ contributions

    GC and YL designed the study. LZ, QW, YZ, JX, CY, YM, MX, RH collected the data. YL and XZ analyzed the data. LZ and GC wrote the manuscript. All authors read and approved the final manuscript.

    Ethics approval and consent to participate

    This study was approved by Ethics Committee of Huaihe Hospital of Henan University and all subjected provided written consent.

    Consent for publication

    Not applicable.

    Competing interests

    The authors declare that they have no competing interests.

    Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

    Authors’ Affiliations

    (1)
    Department of Cardiology, Huaihe Hospital of Henan University, No. 8 Baobei Road, Kaifeng, 475000, China
    (2)
    International Joint Research Laboratory for Cell Medical Engineering of Henan, Huaihe Hospital of Henan University, No. 115 Ximen Street, Kaifeng, 475000, China
    (3)
    Department of Physical Examination Center, Huaihe Hospital of Henan University, No. 8 Baobei Road, Kaifeng, 475000, China

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    Copyright

    © The Author(s). 2019

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